Nursing Elites

1. A 35-year-old woman presents with fatigue, weight gain, and cold intolerance. Laboratory tests reveal high TSH and low free T4 levels. What is the most likely diagnosis?

• A. Hypothyroidism
• B. Hyperthyroidism
• C. Thyroiditis
• D. Thyroid cancer

Correct answer: A

Rationale: The scenario describes a 35-year-old woman with symptoms of fatigue, weight gain, and cold intolerance along with high TSH and low free T4 levels. These findings are consistent with the diagnosis of hypothyroidism. In hypothyroidism, there is decreased thyroid hormone production leading to elevated TSH levels as the body tries to stimulate the thyroid to produce more hormone. The low free T4 levels indicate insufficient thyroid hormone in the blood, which can manifest as symptoms such as fatigue, weight gain, and cold intolerance.

2. The community health nurse is working in a multi-ethnic health center. In what situation should the nurse intervene?

• A. An Asian-American mother reports using cupping to treat an infection, resulting in a pattern of red round marks on her toddler's back.
• B. A Hispanic pregnant client who is often late for appointments arrives late for today's appointment.
• C. A Native-American individual being interviewed will not make direct eye contact when asked about violence in the home.
• D. An African-American infant who is spitting up milk has lost 6 ounces since last week's clinic visit.

Correct answer: D

Rationale: The correct answer is D because losing weight in an infant, especially when combined with spitting up milk, requires immediate intervention to address potential health concerns. Choice A deals with a cultural practice that may not necessarily pose an immediate health risk. Choice B, while important, does not present an immediate health threat. Choice C relates to cultural differences in communication and does not necessarily indicate a need for immediate intervention in terms of health.

3. When should surgical correction of hypospadias typically occur for a newborn infant as advised by the nurse?

• A. Repair should be done within one month to prevent bladder infections.
• B. Repairs should typically be done before the child is potty-trained.
• C. Delaying the repair until school age reduces castration fears.
• D. To form a proper urethra repair, it should be done after sexual maturity.

Correct answer: B

Rationale: Surgical repair of hypospadias is recommended to be performed before the child is potty-trained to prevent complications. Early correction helps in achieving better outcomes and reduces the risk of issues related to urination and development of the genitalia.

4. A 55-year-old man presents with jaundice, pruritus, and dark urine. Laboratory tests reveal elevated bilirubin and alkaline phosphatase. Imaging shows dilated intrahepatic bile ducts and a normal common bile duct. What is the most likely diagnosis?

• A. Primary biliary cirrhosis
• B. Primary sclerosing cholangitis
• C. Gallstones
• D. Pancreatic cancer

Correct answer: A

Rationale: The clinical presentation of jaundice, pruritus, dark urine, elevated bilirubin and alkaline phosphatase, along with imaging findings of dilated intrahepatic bile ducts and a normal common bile duct, are characteristic of primary biliary cirrhosis. Primary biliary cirrhosis is an autoimmune liver disease that leads to destruction of intrahepatic bile ducts, causing cholestasis and liver damage. This condition typically presents in middle-aged women but can also affect men, as seen in this case.

5. A 48-year-old woman presents with fatigue, pruritus, and jaundice. She has a history of ulcerative colitis. Laboratory tests reveal elevated bilirubin and alkaline phosphatase. What is the most likely diagnosis?

• A. Hepatitis B
• B. Primary biliary cirrhosis
• C. Primary sclerosing cholangitis
• D. Autoimmune hepatitis

Correct answer: C

Rationale: The combination of symptoms (fatigue, pruritus, jaundice) along with a history of ulcerative colitis and elevated bilirubin and alkaline phosphatase levels suggests primary sclerosing cholangitis. Primary sclerosing cholangitis is commonly associated with inflammatory bowel disease, such as ulcerative colitis. It is characterized by inflammation and fibrosis of the bile ducts, leading to cholestasis and elevated alkaline phosphatase and bilirubin levels.

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